Health Insurance Marketplace
I’ve recently had my fair share of frustrations…
I’ve recently had my fair share of frustrations when seeking the best options for my family’s health
insurance coverage. In fact, I’d say my brain has been overloaded with so many different aspects of the
enrollment process, types of plans, and thinking through the specific needs for my family. I’d be lying if I
said it was a smooth process, and that I didn’t step away from my laptop in furious anger more than
once. In reality, it’s not that difficult when you take the time to process it all but knowing some basic tips
to get started is helpful.
Open enrollment for both group plans and individual marketplace plans start on Nov 1 st . For typical
group plans, the employer dictates the amount of time you must enroll. In the case of marketplace
plans, you have until December 15th to finish up your election options.
⇒ “My brain has been overloaded…”
Your employer will provide the tools to sign up for your group plan. Healthcare.gov provides all the resources and information needed to sign
up for marketplace coverages. In either of these cases, it is wise to look at your specific needs or family situation and come prepared with the basic idea of the coverage amounts and even budget that works for you.
Let’s look at some basic tips to follow for both group and individual plans.
1. Gather Resources
For group plans, employers typically send out all the resources you need ahead of
time to research the benefits, features, and specific plan options provided to you. In the case of the
marketplace, you can visit state specific websites with information, or visit healthcare.gov and choose
your state to get all the information available to you.
Why does this matter? See #2
2. Plan Early
Review your family needs in detail and be prepared for open enrollment. Think through
expected costs, premiums, and specific features you need.
3. Run the #'s
Beginning in 2023, enrollees won’t have to spend more than $35 per month on insulin. On average, this cost is north of $500 annually. Much more expensive if you need a specific type. Capping costs could help the MILLIONS of people who need this LIFE SAVING medication.
4. HSA Availability
Most plans have high deductibles and allow for savings opportunities. Many group
plans and some marketplace plans allow for HSA’s (Health Savings Accounts). These are tax advantaged
savings options to be used for medical expenses and can be invested like many other investment
accounts for long term savings. It always makes sense to save on taxes!
5. Look for the Full Package
Plans typically offer a bundle of medical, vision, and dental. Take
advantage of the cost savings for bundling these together.
> Plans offer medical, vision and dental
Too Much? Ask for help!
Having researched this for my family, I know this can be overwhelming. Even as I write this, the decision
fatigue of all the options for deductibles, premiums, and coverages can seem to be never ending. That’s
ok – the employer plans and State sites have professionals ready to help you walk through your specific
healthcare needs and find the plan that fits you and your family.
> Make sure it fits YOUR financial plan
Finally, if you have a financial planner, reach out. They can help you make the best choice on your healthcare needs and make sure it
all fits within your overall financial plan. It’s not easy, but with the right research, and even a little help, finding the best health insurance options does not have to ruin your November. And better yet, it can save you from the many frustrations I’ve endured during the process.
Your life and health insurance policies are a key part of your overall financial plan. It’s important to review these policies each year.
If there are gaps, you can work to implement proper coverage.
In this checklist:
- If married and both have access to health coverage, does it make sense to each take coverage or to choose the better of the two plans to cover both?
- If paying for coverage on your own, has your situation changed such that you should consider shopping for a new policy?
- If retired and on Medicare – items specific to your needs and how they work with Medicare plans.
- If covered by life insurance offered by employer, have the coverage options or limits changed?
- For those who own permanent life insurance, it’s a good idea to review the policy including how any dividends are being applied and how the policy is performing.
- For those who own a term policy, review the time left on the policy’s term and consider whether the client’s needs have changed
- If employer provides disability insurance, have there been any changes to this coverage and is it adequate?
- Do other sources of disability income, such as Social Security and personal savings, sufficiently cover potential needs, or should you consider additional insurance?
Long-Term Care Insurance
- Does the policy have appropriate covered services, benefit amounts, and riders, such as inflation protection?
- Have you experienced a large increase in premium? If so, it might make sense to review other options.
Health insurance coverage is often a primary concern for folks who are retiring early. Understanding and weighing options can be complicated and stressful.
- Medicare eligibility
- Availability of coverage through your former employer
- Coverage under your spouse’s health insurance
- COBRA considerations
- The Premium Assistance Tax Credit